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Developing nursing interventions in Paediatric Emergence Delirium: a scoping review
M Earwaker1, N Anderson1, V Egli1
1The School of Nursing, Faculty of Medical and Health Sciences the University of Auckland, Aotearoa New Zealand.
Insights
Emergence Delirium in children, a post-anaesthetic complication, increases risks of injury and prolonged hospital stays. Key nursing interventions focus on child anxiety, post-operative care, continuity, and medication management to minimize these effects.
Area of Science:
- Pediatric Anesthesiology
- Nursing Practice
- Child Psychology
Background:
- Emergence Delirium (ED) in children post-anaesthesia is linked to significant risks including injury, surgical site harm, delayed discharge, and extended hospital stays.
- ED can also lead to emotional and behavioral issues in children weeks after surgery, necessitating careful nursing management.
- While many factors are suspected, their impact on ED and implications for nursing practice require thorough investigation.
Purpose of the Study:
- To conduct a scoping review of Emergence Delirium in pediatric patients.
- To critically synthesize evidence on factors influencing ED in children.
- To inform the development of nursing interventions for preventing or minimizing pediatric ED.
Main Methods:
- A scoping review guided by the PRISMA checklist.
- Inclusion of 14 peer-reviewed studies and guidelines published between 2000 and 2020.
- Deductive thematic analysis of selected literature focusing on ED and nursing practice.
Main Results:
- Child anxiety emerged as a significant factor in managing Emergence Delirium.
- The post-operative phase and continuity of care were identified as crucial themes in nursing management.
- Medication administration practices were also highlighted as key to managing ED in children.
Conclusions:
- Nursing management of pediatric Emergence Delirium should prioritize addressing child anxiety and ensuring seamless post-operative care.
- Further research is needed to explore nurse-led interventions for ED in diverse hospital settings.
- Investigating ED across different healthcare systems can refine prevention and management strategies.
Background:
Children who experience Emergence Delirium following an anaesthetic are at an increased risk of injury, harm to the surgical site, delayed discharge from the recovery room/ post anaesthetic care unit, an increased length of stay in hospital, the requirement of additional nursing staff to care for them and may display additional emotional and behavioural upsets in the weeks following surgery. Many factors have been postulated to be associated with the development of Emergence Delirium in children. However, to date the strength and nature of these associations has not been thoroughly investigated nor discussed considering the specific implications for contemporary nursing practice.
Aim:
The aim of this scoping review is to provide an overview of Emergence Delirium in children, and a critical synthesis of evidence informing development of nursing interventions to prevent or minimise paediatric Emergence Delirium.
Methods:
This scoping review was conducted guided by the PRISMA checklist. 14 peer-reviewed studies and guidelines published between 2000 and 2020 on Emergence Delirium in children and nursing practice were included in the deductive thematic analysis stage.
Results:
The results found the anxiety of the child, the post-operative phase, continuity of care and medication administration were key themes in the nursing management of Emergence Delirium.
Conclusion:
There is opportunity for further research to be conducted on child Emergence Delirium in different hospital systems with further exploration of nurse-led interventions.
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